Transcript File - Huff Hills Ski Patrol

Chapter 19
Burns
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
19.1 List four types of burns.
19.2 List the signs and symptoms for each
type of burn.
19.3 Compare and contrast the methods for
classifying burns.
19.4 Describe the clinical significance of a
voice change in the setting of a thermal
burn.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
19.5 Compare and contrast direct current and
alternating current.
19.6 Describe how to assess burn severity
using the “Rule of Nines” system.
19.7 Describe and demonstrate the
management of a burn patient.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Topics
Anatomy and Physiology
 Burn Sources
 Burn Classifications
 Assessment
 Management
 Chapter Summary

BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Presentation
A 4-year-old boy has pulled a boiling hot dish out of a
microwave and onto himself. The mother is with him
and is crying vigorously. He has no past medical
history, is taking no medications, and has no
allergies.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
 Skin
◦
◦
◦
◦
Largest organ of the body
Two layer
Multipurpose
Vulnerable to damage when exposed to
extreme temperature, caustic
substances, and other hazardous
sources
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Burn Sources
 Thermal
◦ Heat comes directly into contact with
skin
 Chemical
◦ Exposure to a caustic substance
 Electrical
◦ Contact with an electrical current
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Burn Sources
 Radiation
◦ Exposure to a radiation emitting object
◦ UV Light exposure
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Burn Classifications
 Determined
by depth of skin damage
◦ Thickness-based
• Superficial
• Partial thickness
• Full thickness
◦ Degree-based
•
•
•
•
First
Second
Third
Fourth
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Burn Classifications
Copyright Charles Stewart M.D. and Associates
Copyright Edward Dickinson, M.D.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Update
After confirming that the ABCDs are intact, you call
for assistance and begin a secondary assessment.
You note that the boy’s chin and the front of his neck
for a distance of about twice as long as his palms are
bright red and are surrounded by larger areas of
redness in a splash-like pattern. Blisters are forming
on his chest. He is breathing rapidly and his heart
rate is 110 and regular at the brachial artery pulse
point.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
 Scene
safety is a first priority
 Use BSI and PPE
 Airway/breathing is a major concern
 Collect information on the burning
agent
 Determine severity with degree or
thickness based method
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
 Use
the Rule of Nines to determine
extent of partial/full thickness burns
 Check for critical issues
◦ Treatment should be at a burn center if
possible
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 Safety
BRADY
concerns take priority
 Stop the burning process
 Care for ABCDs
 CPR may be needed for electrical
burn patients
 Control bleeding
 Remove clothing and jewelry
 Cool and irrigate with room temp
water
continued
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 Cover
with clean linens/blanket
 After cooling use dry, sterile dressings
 Smaller burns may use clean, wet,
cool dressings
 Do NOT apply creams, ointments,
etc.
 Treat for shock
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 Extensive
Burns
◦ Remember that with extensive burns,
patients lose the ability to
thermoregulate. Make sure they do not
become hypothermic by wrapping them
in warm, dry sheets.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 Elevate
upper body if burned to
minimize edema
 Transport all but most minor burns to
a burn or trauma center if possible
◦ Use a clean, dry sheet to prevent the
patient from sticking to the transport
device.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Thermal Burns
out the flames – “Stop, Drop and
Roll” or smother
 Put
◦ Do not use chemical fire extinguishers
 Remove
burned, singed, or
smoldering clothing, or clothing
soaked in hot liquid
◦ Do not pull if fabric has melted onto skin
 Do
not break blisters
 Do not apply cold compresses
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chemical Burns
 Use
BRADY
PPE to avoid contamination
 Remove all clothing and jewelry
 Consider Hazmat
 Brush off dry chemicals
 Irrigate with large amounts of tepid
water (15 mins, or until burning
ceases)
 Do not try to neutralize
 Chemtrec #: 800.262.8200
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chemical Burns

Chemical Burn Alert
◦ Caution! When managing chemical burns, do not apply a
neutralizing agent because this may cause a thermal
reaction, worsening the injury. Dust off any dry chemicals
and irrigate the area with room-temperature water. Note
as well that the application of water to some chemicals
also produces heat.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Electrical Burns
 Make
sure the power is OFF
 Immobilize on a backboard
 Maintain airway, give oxygen
 Do CPR (use AED) if necessary
 Check for entrance/exit wounds
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Electrical Burns

Entrance and Exit Wounds
◦ Remember that patients injured by electricity often appear
to be much better off than they actually are because many
of their burns are beneath the surface. Take vital signs
frequently and be prepared for extensive resuscitation (CPR
and AED).
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Radiation Burns
 If
the burn is not from ultraviolet light,
the patient should be treated only by
HAZMAT personnel.
 UV burns (sunburn) are usually
treated as first-degree burns.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Disposition
 What
are the patroller’s findings?
 What treatment and transportation
choices were made?
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
 Rescuer
and bystander safety is the
top priority when treating a burn
patient.
 The four types of burns are thermal
burns, chemical burns, electrical
burns, and radiation burns.
 The focus of treatment is stopping the
burning process.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
 Brush
off dry or powdered chemicals
first.
 Irrigate chemical burns with water for
a minimum of 15 minutes.
 Inhalation injuries are often
associated with facial burns and vocal
hoarseness.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
 Burns
are classified by the depth of
the injury.
 Use the Rule of Nines to calculate the
extent of burns.
 Do not delay transport of patients with
significant burns.
 Treat burn patients for shock and
hypothermia.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
 Transport
burn patients to a burn
center or trauma center, whenever
possible.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5/e
©2012 by Pearson Education, Inc., Upper Saddle River, NJ